IL Obesity surgery for kids
emerges as drastic remedy
The Associated Press
The Atlanta Journal Constitution, November 4, 2002
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Drastic surgery for obesity, once viewed as suitable only for
adults, is emerging as an option for children, a new
pediatrics report says.
Whether gastric bypass surgery, which shrinks the stomach from
the size of a football to the size of an egg, might have
long-term side effects for youngsters is unknown. But with
childhood obesity reaching pandemic proportions, some families
and their doctors see it as the only effective solution.
Researchers also haven't determined what age and weight a
youngster should be before surgery, or whether the surgery,
which can result in nutritional deficiencies in adults, could
interfere with a child's use of bone-building calcium, said
authors of a report in November's issue of Pediatrics.
Youngsters in one recent study who underwent gastric bypass
were 15 to 17 years old, a time when peak bone mass is
occurring, said the authors, Dr. Sue Y.S. Kimm of the
University of Pittsburgh and researcher Eva Obarzanek of the
National Heart, Lung and Blood Institute.
Because childhood obesity is so pervasive -- about 15 percent
of youngsters are severely overweight or obese -- more
research "is urgently needed," they said.
Doctors say demand is strong, bolstered in part by famous
patients like pop singer Carnie Wilson, who dropped from about
300 pounds to 148 after an Internet-broadcast surgery in 1999,
at age 31.
Most of the more than 100,000 people who are likely to have
the surgery this year are adults, said Dr. Walter Pories,
president of the American Society for Bariatric Surgery. He
has no exact figures on how many children have undergone
obesity surgery, but in an informal survey of 600 group
members earlier this year, about 10 said they had done
surgeries on children, all with positive results.
Some doctors cringe at the thought of subjecting youngsters to
elective surgery that's so extreme.
"People change their habits. Doing something in the first 20
years that can affect you for the next 50 years ... ethically
it's very hard to justify that," said Dr. Timothy Sentongo, a
gastrointestinal specialist at Chicago's Children's Memorial
For some children who have exercised and dieted to no avail,
surgery is the only alternative, said Dr. Henry Buchwald, a
University of Minnesota surgeon who has done obesity
operations on 18 youngsters under age 18.
"Their life is turned around from being ridiculed at school to
living a normal child's life," he said.
Ideally, patients should have achieved their maximum growth,
said Buchwald, though his youngest was a 13-year-old who was
about 150 pounds overweight.
Families should be told about surgery consequences, which may
include malnutrition and gallstones.
"They're going to have to restrict their eating behavior or
they'll just vomit and be uncomfortable," he said.
Ohio teenager Courtney Dunham says the risks were worth it.
The high school senior says she has been teased since
kindergarten, when a classmate said she triggered earthquakes
when she walked.
Before her Aug. 2 surgery, she weighed 329 pounds -- at
5-feet-3-inches, nearly 200 pounds overweight. So far she's
shed 40 pounds, with no side effects. Her goal is to fit into
size 16 jeans.
"It was a pretty big step, but ... it was the right thing to
do," she said.
Her family is prone to obesity and associated ailments like
diabetes and heart disease, and Courtney knew she was pushing
The doctors assured her that her biggest concern -- that
surgery might rule out eventual motherhood -- was unfounded.
So shortly after her 18th birthday, she underwent a 2 1/2-hour
gastric bypass, the most common type of bariatric surgery, in
which a small stomach pouch is created by stitching the
stomach's upper portion closed.
The intestine is redirected to attach to the pouch and to
bypass a portion of the small intestine that normally absorbs
nutrients. The operation results in weight loss by reducing
food intake and nutrient absorption.
Courtney is now required to eat no more than a cup of food a
few times daily, but must avoid sugar, which can cause
symptoms including nausea, rapid heartbeat and stomach
bleeding after the surgery.
Dr. Victor Garcia, who runs the program with Dr. Thomas Inge,
has done similar operations on about six youngsters; four more
are scheduled for surgery this month.
Not every obese youngster is a candidate, Garcia said.
"We have refused a number of patients for whom we felt the
family would not be supportive," he said. "It's challenging
because most parents are overweight along with the child."